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General NPI Number Information
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NPI Number | 1174643878
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Entity Type | Organization
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Legal Business Name | SPOTSYLVANIA EMERGI-CENTER INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 992 BRAGG RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6979
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Country | US
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Telephone | 540-786-7637
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Fax | 540-786-0810
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Provider Business Mailing Address
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Address Line | 992 BRAGG RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6979
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Country | US
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Telephone | 540-786-7637
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Fax | 540-786-0810
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DESIDERIO LANDAS HEBRON
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Credential | M.D.
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Telephone | 540-786-7637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101022289
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License Number State | VA
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